Healthcare Provider Details

I. General information

NPI: 1043887755
Provider Name (Legal Business Name): SARA LYN CHAMBERS-RIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA LYN CHAMBERS

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 S BROADWAY
LORAIN OH
44053-3821
US

IV. Provider business mailing address

6140 S BROADWAY
LORAIN OH
44053-3821
US

V. Phone/Fax

Practice location:
  • Phone: 440-233-7232
  • Fax: 440-282-4779
Mailing address:
  • Phone: 440-233-7232
  • Fax: 440-282-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162838
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2511873
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: